Interaction between antihypertensives and NSAIDs in primary care: a controlled trial.
BACKGROUND
Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction.


OBJECTIVE
To determine the extent of the interaction between two antihypertensives and three NSAIDs.


METHODS
A prospective clinical trial in a family practice included 88 treated hypertensives aged over 55 years; 39 controls and 49, also taking NSAIDs for osteoarthritis. During this 3-month study, two antihypertensives, lisinopril/hydrochlorothiazide and amlodipine, were compared with three NSAIDs: ibuprofen, acetaminophen, and piroxicam. BP was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting, and supine position.


RESULTS
The average starting blood pressure in the study group was 149.3A+/-9.8/88.6A+/-6.8 mm Hg. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated systolic BP by 7.7-9.9% (p<0.001), which, during the acetaminophen period, decreased by 6.9-9.4% to 0.3-0.9% above baseline (p<0.001), increasing again by 7.0-7.7% (p<0.001) during the second exposition to these drugs. In the amlodipine subgroup, ibuprofen or piroxicam increased BP by 1.1-1.6% (p>0.290) only, and there were no significant shifts in the follow-up periods. Analogous deviations were observed with both measurement devices, in all the examinee's positions. In the control group, BP did not change appreciably.


CONCLUSIONS
Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while acetaminophen is almost inert. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine (ClinicalTrials.gov #NCT00631514).
Pavlicević
Ivancica
I
Split University School of Medicine, Split, Croatia.
Kuzmanić
Marion
M
Rumboldt
Mirjana
M
Rumboldt
Zvonko
Z
D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D004338:Drug Combinations; D004347:Drug Interactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000494:pharmacology / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007052:Ibuprofen / Q000009:adverse effects / Q000627:therapeutic use; D017706:Lisinopril / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy; D010894:Piroxicam / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D010894:Piroxicam; D017311:Amlodipine; D000082:Acetaminophen; D017706:Lisinopril; D007052:Ibuprofen